Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Congella 4013, South Africa

abdoolq2{at}ukzn.ac.za

Is effective, but integration with existing sexual health services remains the biggest challenge

Three randomised controlled trials consistently show that medically performed male circumcision can reduce the acquisition of HIV infection in men by at least 50%.123 In east Africa and southern Africa—where rates of new HIV infections are high and circumcision rates are low—modelling studies estimate that circumcision could reduce the incidence of HIV in men by 50-60%.45 Clearly, the size of this effect would be determined by uptake. If uptake were 100%, an estimated 2 million new infections and 0.3 million deaths in sub-Saharan Africa would be averted over 10 years, and up to 5.7 million new infections would be averted over 20 years.6 In a setting like Orange Farm in South Africa where one of the trials was performed,1 a 50% uptake of male circumcision could avert 32 000-53 000 new infections over 20 years. Conclusions about the effect of male circumcision on the acquisition of HIV in women are awaiting the completion of a trial in Rakai, which is expected in 2008.7